Provider Demographics
NPI:1114749108
Name:VOSTAD, KELSEY (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:VOSTAD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:HEITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5060 CASCADE RD SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3808
Mailing Address - Country:US
Mailing Address - Phone:616-249-0750
Mailing Address - Fax:616-249-0794
Practice Address - Street 1:6500 BYRON CENTER AVE SW STE 202
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9083
Practice Address - Country:US
Practice Address - Phone:616-249-0750
Practice Address - Fax:616-249-0794
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033914225100000X
MI5501304052225100000X
COPTL.0020159225100000X
NV6546225100000X
WAPT61645769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist